Tuberculosis (TB) remains an important public health challenge in India, with an estimated three million new cases and 300,000 deaths annually. In response, the Ministry of Health and Family Welfare has enhanced the Nikshay Poshan Yojana (NPY) by doubling the direct benefit transfer from ₹500 to ₹1,000 per month for the entire treatment duration. The initiative also includes a one-time disbursement of ₹3,000 upon diagnosis, aiming to address the nutritional and economic needs of patients. This scheme positions India uniquely among high TB burden countries, as it not only targets medical treatment but also the socioeconomic factors contributing to the disease’s prevalence.
The Role of Nutrition in TB Treatment
Nutritional status plays a critical role in the management and outcomes of TB. Severe undernutrition is prevalent among TB patients, with average weights below healthy benchmarks—43 kg for men and 38 kg for women at diagnosis. Malnutrition exacerbates TB’s effects, leading to poorer treatment outcomes and increased mortality rates. Research indicates that nutritional support can enhance treatment adherence and weight gain, facilitating a successful return to work and reducing mortality risks.
Social Determinants of Health
TB is not merely a medical condition; it is deeply intertwined with social determinants such as poverty, overcrowding, and inadequate nutrition. These factors increase susceptibility to TB and complicate treatment adherence. For instance, undernutrition contributes to nearly half of new TB cases in India. The interplay between socioeconomic status and health outcomes is evident, as those living in poverty often face barriers to accessing quality healthcare, leading to a vicious cycle of disease and economic hardship.
Implementation Challenges of NPY
Despite the promising framework of the NPY, several challenges hinder its effectiveness. The evaluation by the National Institute of Epidemiology (NIE) brought into light that non-receipt of benefits was associated with a four-fold increase in adverse outcomes. Many vulnerable communities lack access to essential identification documents, bank accounts, or face geographical barriers, preventing them from receiving necessary support. Furthermore, the existing TB programme staff are often overburdened with new initiatives, detracting from their ability to facilitate the NPY effectively.
Strategies for Improvement
To enhance the efficacy of the NPY, several strategies should be considered. First, dedicated human resources should be allocated to NPY activities to ensure effective implementation. Second, culturally relevant counselling materials should be developed to educate patients and their families about the importance of nutrition in TB treatment. Emphasising locally available food sources, such as pulses and dairy, can be more sustainable and acceptable than commercial nutritional supplements.
Evidence-Based Interventions
The RATIONS trial demonstrated that providing a 10 kg monthly food basket improved early weight gain, correlating with a 50% reduction in mortality risk. Additionally, low-cost interventions, such as food baskets combined with micronutrient supplements, have shown potential in reducing new TB cases by up to 50%. These findings underscore the importance of integrating nutritional support into TB treatment protocols.
Addressing Stigma and Social Integration
The stigma associated with TB can deter patients from seeking help and participating in support programmes. It is crucial to implement measures that protect patient identity and promote dignity in receiving assistance. Additionally, integrating nutritional, financial, and social support initiatives with comprehensive care—such as uninterrupted drug supply and better management of comorbidities—can enhance patient outcomes.
UPSC Question:
Critically discuss the impact of nutritional support on the treatment outcomes of tuberculosis in India.
